Transforming Patient Compliance Research in an Era of Biomedicalization

Abstract

How can research on patient compliance be updated to reflect the realities of today's health and medical landscapes? The idea of patient compliance first proliferated in the 1970s, an era when physicians had a great deal of authority, healthcare was less corporate, pharmaceutical options were simpler, and the Internet was nonexistent. Saying a patient was "noncompliant" was a way of pointing to deviant behavior that was not aligned with medical demands (and therefore, presumably, patients' own interests). Fifty years later, today's medical landscape is very different in ways that limit the usefulness of the original concept. The social sciences have a range of tools that can (and should) be applied to update this concept, which is critical for understanding where medicine is successful, where it fails, and how people manage their health. This article uses qualitative interviews with terminally ill patients (n = 26) and their caregivers (n = 16) to examine how end-of-life decision making reveals much about the current health landscape and what it means to follow (or not) medical advice. The case of end-of-life decision making is informative precisely because it falls at an intersection of many changes that have occurred in recent decades: there are more options for treating serious illnesses than ever before but also more options for palliative care, hospice, and assisted death. Information is also more accessible than ever before. Qualitative thematic analysis facilitated the identification of patterns and key junctures in decision-making processes.

How HIV Clients Find Their Way Back to the ART Clinic: A Qualitative Study of Disengagement and Re-engagement with HIV Care in Malawi

“…Our findings highlight the importance of client-centered care and more flexible ART appointment schedules that acknowledge and address the challenges of competing and unexpected life events. Missed ART appointments may reflect logical rationales and calculated tradeoffs, rather than a disregard for the importance of routine HIV care [54]. Effective HIV care retention and re-engagement interventions (e.g., treatment supporters, patient navigation, and social support services) in other settings are those that consider and address the myriad factors in the lives of PLWH, outside of the clinic, that may conflict with or take higher short-term priority than attending ART appointments [55][56][57][58].…”

The Impact of Narrative Reviews on Patient E-doctor Choice in Online Health Communities

“…The traditional patient-doctor relationship is based on the assumption that healthcare professionals know what is best for patients. 32 However, knowledge gained from OHCs informs and empowers patients. In addition, patients with chronic diseases often have a greater understanding of their conditions and the ability to evaluate the treatment effects of Internal Medicine doctors.…”

From Compliance to Adherence in Diabetes Self-Care: Examining the Role of Patient’s Potential for Mindful Non-Adherence and Physician-Patient Communication

“…25 Given that the term “compliance” implies a passive action, some scholars have associated it with the issues surrounding the dominance of medicine where patients surrender all decision-making and control to health care providers. 26,27…”

“…25 Given that the term "compliance" implies a passive action, some scholars have associated it with the issues surrounding the dominance of medicine where patients surrender all decision-making and control to health care providers. 26,27 Adherence, on the other hand, implies persistence in practice and maintenance of behavior beyond compliance. 28,29 Coming from the Latin word adhaerere, which means "to cling to, keep close, or remain constant," adherence refers not to the accurate following of rules but rather to the extent to which the individual keeps following the previously accepted rules.…”